Week 6:
A Look into My Future

July 24, 2017

I had the opportunity to shadow Dr. Leal in geriatric psychiatry again and loved it just as much as the first time. There is always something new to learn about. This time around was a very different experience because the third-year medical students and psychiatry residents began their psych rounds. I was able to see the role of a medical student in clinic. This gave me a good look into what my future in medicine will be like.

I had an incredible experience the second day I shadowed in geriatric psychiatry. A patient was admitted for psychosis, including visual and auditory hallucinations and severe paranoia. The patient has progressed to the point that they are seeing faces in rugs and sheets, hearing voices, and seeing shadows. The shadows were initially only seen at night, but are now also being seen during the day. The very interesting point is that the patient was previously diagnosed with RBD!!! When I discovered this, I instantly thought to ask about possible neurodegenerative disorders, as a high proportion of patients diagnosed with RBD will progress to suffer from synucleinopathies such as Parkinson’s disorder, dementia with Lewy bodies (DLB) and multiple system atrophy (MSA). I was able to converse with the physicians about what could be happening with this patient. I learned that DLB can present with psychosis, which moved the team to look into the patient’s recent neurology workups. After shadowing, I was able to sit down with Dr. St. Louis who is treating the patient for RBD. He does not believe the patient is developing DLB, but rather has a primarily psychiatric diagnosis. Another probable diagnosis could be depression with psychosis, secondary to the stress from dealing with RBD.

This was an incredibly exciting and educational experience, and gave me insight into what it’s like to be a practitioner solving the mystery of diagnosis. Everything I am doing at Mayo is ensuring me of my love for medicine and reinforcing my decision to pursue a career in the fields of neurology and psychiatry.

On Wednesday, we went to the Medical Grand Rounds presentation on individualized medicine. The lecturer spoke about the role of genetic testing in various fields of medicine and its implications. One part of the presentation that was particularly interesting to me was about pharmacogenetics. We now have the technology to sequence an individual’s entire genome and know the drugs they will have adverse reactions towards. This sequencing can also tell what drugs the individual should be treated with for the best response. This groundbreaking work can entirely change the way we treat patients.

Involving the 4-limb pilot PSG project I am working on, I have made incredible progress this week. I have retrieved all of the PSG files from the archives and have finished scoring 3/4 of the files. Hopefully by next week, I will be able to start analyzing and interpreting the data. The Belgian software finally came in, so we are in the process of getting that installed. Once installed, we can run the files and compare my scoring to the software’s.